Cerebral oximetry during extracorporeal cardiopulmonary resuscitation

Brain damage remains the most important cause of morbidity and mortality among survivors after cardiac arrest. However, it remains unclear how systemic hemodynamics should be adjusted to ensure adequate cerebral oxygenation. Cerebral oximetry has been used to optimize cerebral perfusion during conventional CPR [1], and very low cerebral saturation (<40%) may predict poor neurological outcomes at hospital discharge in patients with OHCA [2]. ECMO has been shown to be effective to resuscitate adult patients following refractory cardiac arrest with intact neurological outcomes in 15% to 30% of cases [3,4]. Nevertheless, only scarce data are available on the adequacy of cerebral oxygenation during eCPR, and most of them focus on pediatric patients. In one retrospective study, Wong and colleagues [5] described their experience with cerebral oximetry monitoring in 20 adult patients with ECMO; in this population, low cerebral saturation occurred in all patients and was corrected in 80% of them by various interventions to optimize brain perfusion, including increasing MAP or ECMO blood flow [5]. In our patient, cerebral saturation remained very low during CPR and only just exceeded 40% with initial ECMO settings, and both of these factors probably were implicated in the irreversible brain damage.We suggest that cerebral oximetry be used to rapidly adjust ECMO blood flow to provide adequate brain oxygenation in patients undergoing eCPR. The impact of such an approach on outcomes warrants further evaluation.CPR: cardiopulmonary resuscitation; ECMO: extracorporeal membrane oxygenation; eCPR: extracorporeal cardiopulmonary resuscitation; MAP: mean arterial pressure; OHCA: out-of-hospital cardiac arrest; PaO2: arterial partial oxygen pressure; StO2' tissue hemoglobin saturation.The authors declare that they have no competing interests.DF, DdB, and BR were directly involved in the medical management of the patient. FST was responsible for cerebral oximetry monitoring. All authors